It's a public holiday but surgeon Li Yang is surrounded by students at a university lecture theatre in Beijing as they cram for the tests that would allow them to practise medicine in the United States.

Cutting back on his clinic hours at a hospital, Li founded Baige Medical a few years ago to create one of a growing number of companies on the mainland that prepare medical students and doctors for the two-part professional exam.

On this morning, Li was briefing students before giving a lecture - one of 39 in the Baige programme - later in the day on digestive tract disorders.

Only in recent years have young doctors and medical students started studying for the US Medical Licensing Examination (USMLE) while still in China. The more well-trodden path has been to first apply for a job in the US and then prepare for the test there.

"[The candidates] are much younger than in my time," said Li, aged 37, who passed the exam on home turf in 2009.

Back then he and several other young doctors met regularly at restaurants to compare notes and discuss cases in mock tests. That planted the seed for the business.

"Two years later we had one passing the first test, and we knew we could use this way to help others," Li said.

After two of the group members passed the second step, Li thought he could make it easier for those who wanted to follow the same path.

Today, he frequently travels to medical schools across the country to promote the idea of preparing for the exams while still in medical school at home.

Li said Baige Medical had 16 employees and no one was doing the work just for the money, adding that the firm had turned down some job applicants who only wanted to be full-time lecturers at the school.

"For me it's a business with social implications. We want to train more top doctors with an international standard and vision," he said.

"We want to train more doctors with better qualifications, and we [want to] have more such doctors to work with patients."

China has its own set of medical exams that a person must pass before becoming a doctor, but the US tests are far more complex and require a greater knowledge of the field, doctors and other medical professionals say.

"The [US] exam is far more difficult," Li said. "The mainland exams are still all about rote learning from books and getting a passing [score] while the USMLE is about selecting the best."

Yang Mianhua, deputy dean of Shantou University Medical College, agreed that the local board exams had a lot of shortcomings.

"The USMLE requires a comprehensive understanding of the material and focuses more on clinical skills," Yang said.

The university started using the US test materials in its own classes several years ago as part of a project to improve medical education. It offered students with a good command of English the chance to be taught by foreign lecturers using overseas textbooks.

At first the tests were simply study tools but then some of the students sat the first of the US exams. In the initial year, all 11 of the students who sat step one passed. In the second year, 22 of the 23 candidates passed.

"Some 90 per cent of students passed the exam, which is very high," said Yang, adding that the school encourages students to take the exam not solely to become doctors in the US but also to see how much they have learned.

Wang Qun, a fourth-year student from Shanxi Medical University, said most Chinese students wanted to go abroad to practise medicine.

"I want to practise in the States because it is a purer place to practise medicine," Wang said.

For Luo Yiming, a 23-year-old Peking University medical student, preparing for the exam gave him more motivation to practise medicine. After spending 1,500 hours studying for and then passing the exams, Luo is giving lectures at Baige Medical to help other candidates succeed.

"The exam has a lot of questions about the doctor-patient relationship and ethics. I came to understand that being a doctor is about taking the ultimate care of another person," Luo said.

He said the biggest difference between being a doctor in the US and in China was the culture of medicine.

"The US pays more attention to how the patient feels and overall care. The situation in China is discouraging, [and] there are many details on which doctors can improve," Luo said.

Ann Law, medical project manager of Hongjing International Education, which also prepares people for the USMLE, echoed those thoughts.

"You are not just a doctor but need to handle relationships with an administration, nurse or [another] family doctor. You need to put yourself in a scenario and think of the best interests of the patient," she said.

"It requires a change of mentality to adjust to the cultural differences between China and the US."

Law said there were 170 medical schools on the mainland whose graduates were eligible to take the exam and 52 of the schools taught classes in both Chinese and English.

"Some local students are weak in English and we can help them. We are very optimistic about the market," she said.

Law also said there were many students from India and Pakistan in China, and a growing number from the US and Canada. As many as 60,000 overseas students were studying in Chinese medical schools.

About 90 per cent of students at Southern Medical University in Guangzhou, for example, were from India. Some of them would return home to practise medicine but some would go on to the United States.

This article appeared in the South China Morning Post print edition as Putting doctors to the U.S. test